On WebMD there is a fun and informative QUIZ: “How Much Do You Know About Jaw Pain?”
Here’s the link:
The more you know, the better. Have fun.
First described in 1981, floppy eye syndrome (FES) is characterized by very elastic upper lids that become easily distorted and everted with minimal lateral traction. In a case-control study, Ezra et al have found that FES appears to be strongly associated with obstructive sleep apnea-hypopnea syndrome (OSAHS) and keratoconus. The study involved 102 FES patients and a control group of patients from a diabetic retinopathy clinic who were matched 1:1 in terms of age, body mass index (BMI), and sex. Not only did they find significant associations between FES and OSAHS and keratoconus, but between lash ptosis, dermatochalasis, upper lid medial canthal laxity, upper lid distraction, palpebral aperture, and levator function as well. In addition, while FES was more common in obese males in their 6th decade, the condition affected patients with a significant range of ages, BMI, and sex. The authors urge clinicians to keep in mind this strong association between FES and OSAHS and keratoconus when determining course of treatment.
*From the April, 2011 issue of American Journal of Ophthalmology
Myofascial Pain Syndrome
The main innovation of Travell’s work was the introduction of the myofascial pain syndrome concept (myofascial referring to the combination of muscle and fascia). This is described as a focal hyperirritability in muscle that can strongly modulate central nervous system functions. Travell and followers distinguish this from fibromyalgia, which is characterized by widespread pain and tenderness and is described as a central augmentation of nociception giving rise to deep tissue tenderness that includes muscles. Studies estimate that in 75–95 percent of cases, myofascial pain is a primary cause of regional pain. Myofascial pain is associated with muscle tenderness that arises from trigger points, focal points of tenderness, a few millimeters in diameter, found at multiple sites in a muscle and the fascia of muscle tissue. Biopsy tests found that trigger points were hyperirritable and electrically active muscle spindles in general muscle tissue.
Qualities of trigger points
Trigger points have a number of qualities. They may be classified as potential, active/latent and also as key/satellites and primary/secondary.
There are a few more than 620 potential trigger points possible in human muscles. These trigger points, when they become active or latent, show up in the same places in muscles in every person. That is, trigger point maps can be made that are accurate for everyone.
An active trigger point is one that actively refers pain either locally or to another location (most trigger points refer pain elsewhere in the body along nerve pathways). A latent trigger point is one that exists, but does not yet refer pain actively, but may do so when pressure or strain is applied to the myoskeletal structure containing the trigger point. Latent trigger points can influence muscle activation patterns, which can result in poorer muscle coordination and balance. Active and latent trigger points are also known as “Yipe” points, for obvious reasons.
A key trigger point is one that has a pain referral pattern along a nerve pathway that activates a latent trigger point on the pathway, or creates it. A satellite trigger point is one which is activated by a key trigger point. Successfully treating the key trigger point will often resolve the satellite, either converting it from being active to latent or completely treating it.
In contrast, a primary trigger point in many cases will biomechanically activate a secondary trigger point in another structure. Treating the primary trigger point does not treat the secondary trigger point.
Potential causes of trigger points
Activation of trigger points may be caused by a number of factors, including acute or chronic muscle overload, activation by other trigger points (key/satellite, primary/secondary), disease, psychological distress (via systemic inflammation), homeostatic imbalances, direct trauma to the region, accident trauma (such as a car accident which stresses many muscles and causes instant trigger points) radiculopathy, infections and health issues such as smoking.
Trigger points form only in muscles. They form as a local contraction in a small number of muscle fibers in a larger muscle or muscle bundle. These in turn can pull on tendons and ligaments associated with the muscle and can cause pain deep within a joint where there are no muscles. When muscle fibers contract, they use biochemical energy, and depletion of these biochemicals leads to accumulation of fatigue toxins such as lactic acid. The tightened muscle fibers constrict capillaries and prevent them from carrying off the fatigue toxins to the body’s recycling system (liver and kidneys) . The buildup of these toxins in a muscle bundle or muscle feels like a tight muscle—a slippery elongate bundle.
When trigger points are present in muscles there is often pain and weakness in the associated structures. These pain patterns in muscles follow specific nerve pathways and have been readily mapped to allow for identification of the causative pain factor. Many trigger points have pain patterns that overlap, and some create reciprocal cyclic relationships that need to be treated extensively to remove them.
click here for a quick video that explains TMJ Trigger Points
The SomnoDent® is an oral device, which fits over the upper and lower teeth, much like a sports mouthguard. However unlike a sports mouthguard it is a discreet, precision-made and clinically-tested medical device that is recognized for its clinical validity by FDA,TGA, ISO 13485 and Swiss medic standards. Backed by over 7 Years of clinical research it is no wonder that the SomnoDent® is known as the MAS GOLD STANDARD among Dental Sleep Professionals across the world.
OBSTRUCTIVE SLEEP APNEA
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